Clinical Decision Rules to Improve the Detection of Adverse Drug Events in Emergency Department Patients

Hohl, Corinne M.; Yu, Eugenia; Hunte, Garth; Brubacher, Jeffrey R.; Hosseini, Faegheh; Argent, Chelsea P.; Chan, Winnie Wai Lan; Wiens, Matthew O.; Sheps, Samuel B.; Singer, Joel

doi:10.1111/j.1553-2712.2012.01379.x

Cited by 56 publications

(143 citation statements)

References 34 publications

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“…The criteria used to identify the at-risk patient population were modified from the criteria of Hohl and others 9 for identifying adverse drug events. Because of the convenience sample size, only CNS medications, number of overall medications, and age appeared to increase the number and severity of discrepancies.…”

Section: Discussionmentioning

confidence: 99%

“…After the interviews and data collection were completed, patients considered to be at risk for adverse drug events were identified from among the interviewed patients using criteria modified from those of Hohl and others 9 (i.e., 1 or more classes of a medication or antibiotic used within the past 7 days plus age > 80 years or a medication start or stop within the past month).…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, Canadian emergency departments must develop a risk assessment approach to identify these groups. Hohl and others 9 have produced criteria for identifying patients at risk of adverse drug events, including adverse drug reactions. These criteria are intended to lead to an adverse drug event assessment by a clinical pharmacist, which presumably would include obtaining a BPMH.…”

Section: 3mentioning

confidence: 99%

“…The primary objective of this study was to determine the percentage of patients in the non-admitted area of the emergency department who could complete a guided BPMH form with no clinically significant discrepancies (defined as no major discrepancies and no more than 1 moderate discrepancy). The secondary objectives were to identify the proportion of patients who recorded responses to all of the questions on the guided form, the type and incidence of discrepancies observed between the self-completed form and information gathered by a pharmacy team member, patients' perceptions about the request to complete a BPMH form before assessment, and the proportion of patients who met both the project's high-risk criteria (as modified from Hohl and others 9 ) and the primary outcome in the current study.…”

Section: 3mentioning

confidence: 99%

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Reliability of Best Possible Medication Histories Completed by Non-admitted Patients in the Emergency Department

Macdonald

Manuel

Brennan

et al. 2017

CJHP

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Background: Accreditation standards have outlined the need for staff in emergency departments to initiate the medication reconciliation process for patients who are at risk of adverse drug events. The authors hypothesized that a guided form could be used by non-admitted patients in the emergency department to assist with completion of a best possible medication history (BPMH). Objective: To determine the percentage of patients in the non-acute care area of the emergency department who could complete a guided BPMH form with no clinically significant discrepancies (defined as no major discrepancies and no more than 1 moderate discrepancy). Methods: This prospective exploratory study was conducted over 4 weeks in February and March 2016. Data were collected using the self-administered BPMH form, patient interviews, and a data collection form. After completion of the guided BPMH form, patients were randomly selected for interview by a pharmacy team member to ensure their self-completed BPMH forms were complete and accurate. Eligible patients were those with non-acute needs who had undergone triage to the waiting room. Patients who were already admitted and those with immediate triage to the acute care or trauma area of the emergency department were excluded. Results: Of the 160 patients who were interviewed, 146 (91.3%) completed the form with no more than 1 moderate discrepancy (but some number of minor discrepancies). There were no discrepancies in 31 (19.4%) of the BPMH forms, and 101 (63.1%) of the forms had only minor discrepancies. Conclusions: Most of the patients interviewed by the pharmacy team were able to complete the BPMH form with no clinically significant discrepancies. The self-administered BPMH form would be a useful tool to initiate medication reconciliation in the emergency department for this patient population, but used on its own, it would not be a reliable source of BPMH information, given the relatively low number of patients who completed the form with no discrepancies.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: 3mentioning

confidence: 99%

Section: 3mentioning

confidence: 99%

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Reliability of Best Possible Medication Histories Completed by Non-admitted Patients in the Emergency Department

Macdonald

Manuel

Brennan

et al. 2017

CJHP

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“…To the Editor: Hohl and colleagues 1 recently published clinical decision rules (CDRs) that may enable the identification of patients visiting the emergency department (ED) with a high risk of adverse drug events (ADEs) for medication review by a medication specialist. This is the first attempt to propose a resource-efficient, systematic ADE screening tool in the ED patient population, with parsimonious rules that make clinical sense.…”

mentioning

confidence: 99%

Clinical Decision Rules to Improve Adverse Drug Events

Roulet

Ballereau

Asseray

2012

Academic Emergency Medicine

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Hohl and colleagues 1 recently published clinical decision rules (CDRs) that may enable the identification of patients visiting the emergency department (ED) with a high risk of adverse drug events (ADEs) for medication review by a medication specialist. This is the first attempt to propose a resource-efficient, systematic ADE screening tool in the ED patient population, with parsimonious rules that make clinical sense. Nevertheless, these results deserve some comments.The study exclusively focused on ADEs that were the leading cause of the patients ED visit. However, an earlier study conducted in the same setting, among elder patients presenting to the ED, demonstrated that there was better recognition of those ADEs related to the patients chief complaint, compared with recognition of ADEs that were not associated with the chief complaint (91% vs. 32.1%, respectively).2 These results highlight the importance of taking into account ADEs that are not associated with the chief complaint when working to improve ADE recognition among the ED patients.Through the application of a few criteria, the ADE rule yielded a sensitivity of 96.7%, but with a specificity that could be regarded as insufficient to fit with the organization of many EDs. These CDRs recommend the medication review by a medication specialist once the patient has at least one comorbid condition, and he or she takes at least three prescription medications, which is a very frequent combination among patients presenting to the ED. This limitation is confirmed by the high number of patients requiring medication review when using the ADE rule (about 4 in 10 patients). A second rule was derived taking into account the resource constraints of smaller centers with less pharmacist and medical consultant availability. Despite this second rule being focused on moderate and severe adverse drug reactions, the proportion of ED patients requiring medication review remained high (about 3 in 10 patients). The medication review in so many patients in real time, at the time of the care, is difficult to implement without establishing a permanent pharmacy presence in the ED, which is not the practice in most EDs. A simple way to limit the number of case reviews may be to build a tool that would specifically identify those ADEs that were not recognized by the emergency physicians and would not make the emergency physicians review the cases where they spontaneously recognized an ADE. Further investigations are needed to address this issue.

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Tolerability of lithium: A naturalistic discontinuation study in older inpatients (≥60 years)

Flapper

Melick

Campen

et al. 2021

Int J Geriat Psychiatry

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Objectives Lithium is one of the most effective treatment options in both bipolar disorder and treatment‐resistant depression. The use of lithium in older patients declined during the last decades, probably resulting in undertreatment of older patients. To investigate how well lithium is tolerated in old age, we aimed to determine the frequency, reasons, and possible predictors of discontinuation due to adverse effects in a cohort of inpatients ≥60 years who had started with lithium. Methods We performed a retrospective cohort study based on chart reviews. Participants were in treatment at Parnassia Group at The Hague, The Netherlands. After inclusion (between January 2010 and December 2016), participants were followed until April 2017, when we performed data extraction and analysis. Results In our sample of 135 patients (median age 69 years, median follow‐up duration 18 months), 49 (36.3%) participants discontinued lithium. Only a minority (11 [8.1%]) of the participants discontinued solely due to adverse effects. The majority discontinued lithium due to psychiatric (18, 5%) reasons (most commonly mentioned within this subgroup: lack of effectiveness and noncompliance) or a combination of reasons (7.4%). None of the factors we studied (age, gender, Charlson Comorbidity Index, polypharmacy, renal function, and neurological history) were significantly associated with discontinuation due to adverse effects. Conclusions The frequency of lithium discontinuation in our cohort was in range with frequencies reported in younger patients. Older age itself should not be a reason to withhold lithium treatment.

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Clinical Decision Rules to Improve the Detection of Adverse Drug Events in Emergency Department Patients

Cited by 56 publications

References 34 publications

Reliability of Best Possible Medication Histories Completed by Non-admitted Patients in the Emergency Department

Reliability of Best Possible Medication Histories Completed by Non-admitted Patients in the Emergency Department

Clinical Decision Rules to Improve Adverse Drug Events

Tolerability of lithium: A naturalistic discontinuation study in older inpatients (≥60 years)

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